Davidson, Benton John

Davidson, Benton John is an sole proprietor health care provider with primary practice located at 1174 Cornucopia St Nw Suite 240, Salem OR 97304-3193. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Clinical Neurophysiology. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Davidson, Benton John can be contacted via phone (503) 385-1664.

Contact Information

Primary practice address
1174 Cornucopia St Nw Suite 240 Salem OR 97304-3193
Phone: (503) 385-1664
Fax: (503) 991-5768
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X MD21643 Oregon
Allopathic & Osteopathic Physicians / Clinical Neurophysiology 2084N0600X MD21643 Oregon

Profile Details

NPI number 1013944016
LBN Legal business name Davidson, Benton John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 26th, 2006
Last updated Mar 28th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013944016 NPPES
Oregon MEDICAID 288103

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